Project Summary/Abstract In utero exposure to opioids is causing significant societal concern given the worsening statistics of opioid-related use and abuse in women of child-bearing age. Over the past 2 decades, the rate of opiate usage across the US has increased by >300%, the number of opioid-related deaths has increased by ~500% and the number of newborns with neonatal abstinence syndrome (NAS) has increased by almost 400%. Thus, the opioid crisis represents a constellation of adverse conditions that places the developing child at significantly increased risk for mortality, small gestational growth, preterm delivery, postnatal failure to thrive and worsened neurobehavioral, scholastic, and societal outcomes. Emerging data indicate that in utero substance exposure is associated with a variety of negative health and cognitive outcomes. We assume the association between prenatal substance exposure and mental health/cognitive outcomes is mediated by the impact of prenatal substance exposure on brain development; we further assume that background environmental variables, such as low SES, low maternal education and high levels of stress exposure, moderate these developmental sequelae. In this linked proposal we will use a battery of behavioral and neuroimaging tools, beginning late prenatal and extending into school age, to examine the effects of opioid and adversity exposure on development.